ObjectiveTo report our clinical experience and outcomes of thoracic endovascular aortic repair (TEVAR) for acute Stanford type A dissection using ascending aorta replacement combined with implantation of a fenestrated stent-graft of the entire aortic arch through a minimally invasive technique. MethodsFrom 2016 to 2020 in our hospital, 24 patients (17 males and 7 females, aged 45-72 years) with complicated Stanford type A aortic dissection, underwent replacement of the proximal ascending aorta with TEVAR. None of the patients with dissection involved the three branches of the superior arch, and all patients were replaced with artificial blood vessels of the ascending aorta under non-hypothermic cardiopulmonary bypass, preserving the arch and the three branches above the arch, and individualized stent graft fenestration. ResultsSurgical technical success rate was 100.0%. There was no intraoperative complication or evidence of endo-leak in 1 month postoperatively. Hospital stay was 10±5 d. During postoperative follow-up, the stent was unobstructed without displacement, the preserved branch of the aortic arch was unobstructed, and the true lumen of the descending aorta was enlarged. Conclusion This hybrid technique by using TEVAR with fenestrated treatment is a minimally invasive and effective method to treat high-risk patients with acute Stanford type A aortic dissection.
This article reports a case of a 70-year-old female patient who developed bioprosthetic mitral valve deterioration 4 months after her initial valve replacement surgery, manifesting as severe regurgitation and New York Heart Association Class Ⅲ. Due to the high risk of a redo open-heart surgery, she underwent a transapical transcatheter mitral valve-in-valve procedure. Intraoperatively, a J-Valve prosthesis was successfully implanted under echocardiographic and fluoroscopic guidance. Immediate transesophageal echocardiography confirmed an optimal valve position, complete resolution of regurgitation, and no significant paravalvular leak or left ventricular outflow tract obstruction. The patient's postoperative course was uneventful. She was extubated 16 hours post-procedure with significant improvement in cardiac function. Follow-up echocardiography showed normal prosthetic valve function.